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Biomedical subjects

C Chatelain

Publications and source records attributed to C Chatelain.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Endoscopic surveillance of superficial papillary tumors of the bladder].

All cases of superficial bladder tumor treated in 1991 at the urology department of La Pitié hospital were reviewed to study the course of superficial bladder tumors with regard to the risk of muscle infiltration and the value of endoscopic follow-up. In 1991, 73 patients (63 men and 10 women) with a mean age of 64 years had TUR for superficial bladder tumor. Patients had repeated cystoscopy at 3 and 6 months and then on a yearly basis for 5 years. Fourty-eight patients had TIS tumors, and 19 patients had T1 tumors. Five patients were lost to follow-up. Sixty-eight patients were followed for 5 years. Of 48 patients with stage TIS tumors, 39 (81.5%) did not show any deterioration at histological examination, eight patients (16.5%) had infiltration of the lamina propria by tumor (pT1) and the tumor invaded muscle in one patient (2%). Of the 19 patients with stage T1 tumors at the first TUR eight (47%) had no pathologic deterioration, but nine (53%) developed muscle invasion (pT2). Two patients were lost to follow-up. Invasion of the lamina propria present at diagnosis or during the subsequent course is considered to be an indicator of high risk of progression to muscle invasive disease (over 50% of cases). The prognostic accuracy of both the grade and stage needs to be enhanced using molecular markers.

Carcinoma in Situ↗
PubMed1998

[Survival of patients with infiltrating tumors of the bladder treated with cystectomy].

We reviewed the results of infiltrating bladder cancer treated by radical cystectomy to evaluate survival. Between January 1989 and December 1992, a total of 58 consecutive cystectomies or anterior pelvectomies performed on 48 men and 10 women (mean age 63.2 years) in our department were retrospectively evaluated. Four patients were lost to follow-up and the mean follow-up was 72 months. Pathologic staging was as follows: stage pT0,A,1: 13.5%, stage pT2: 17.5%, stage pT3a: 12%, stage pT3b: 36%, stage pT4: 21%. The year probability of the overall survival was 60% for p T2-p T3a patients, 15% for pT3b patients, and 9% for pT4 patients, respectively. Overall, 53.5% of patients died of cancer, 7.5% of intercurrent disease, and 39% were alive. The cancer related death rate was 12% for pT2-pT3a patients, and 82% for pT3b-pT4 patients. The 5- year probability of specific survival was 80% for pT2-pT3a patients, 15% for pT3b patients, and 9% for pT4 patients, respectively. Infiltrating bladder cancer still has a high mortality rate. Radical cystectomy may be considered to be a curative procedure for stages pT2 and pT3a. Adjuvant chemotherapy and/or radiotherapy seem necessary at stages pT3b and pT4. Preoperative criteria need to be better defined to reduce understaging.

Carcinoma↗
PubMed1997

Results of renal transplantation in patients with Schistosoma infection.

PURPOSE: We evaluated the results of renal transplantation in patients infected with Schistosoma haematobium, as well as the risks of urological complications and post-transplant reinfection. MATERIALS AND METHODS: The outcome of 20 kidney transplants was retrospectively studied. Based on our experience and review of the literature, our clinical practice to prevent urological complications consisted of antischistosomal chemotherapy given at the pre-transplant evaluation, with endovesical ureteroneocystostomy preferred in case of bladder calcifications. A Foley catheter was maintained for 10 days. A transurethral bladder neck incision was performed before removal of the Foley catheter when bladder neck sclerosis was present. RESULTS: The 1 and 2-year patient survival rate was 93%, and 1 and 2-year graft survival rates were 88 and 81%, respectively, which were not different from those of a cohort of 167 patients without schistosomal infection. Surgical complications included 2 postoperative hemorrhages, 2 urinary leaks and 1 nonschistosomal related ureteral stricture. Post-transplant schistosomal infection never occurred when antischistosomal chemotherapy was given at the pre-transplant evaluation. CONCLUSIONS: Patients with schistosomal infection are suitable recipients for kidney transplantation, although they are at risk for urological complications. Unlike other infectious diseases, such as tuberculosis, the risk of recurrence due to reactivation of chronically hosted pathogens seems to be low or absent in patients who received antischistosomal chemotherapy at the pre-transplant evaluation. Long-term urological followup is recommended, including urethrocystoscopy, because of the theoretically increased risk for bladder malignancy.

Adult↗
PubMed1997

[Isolated Burch type indirect colposuspension of the bladder neck in the treatment of stress urinary incontinence in women. Long-term results].

OBJECTIVES: Burch indirect colposuspension remains the reference surgical operation in the treatment of female urinary stress incontinence. The stability of the results is highly controversial and the causes of failure remain hypothetical. The objective of this study was to analyse the long-term results of this technique. METHODS: 100 women suffering from pure urinary stress incontinence, in whom a Burch indirect colposuspension was performed, were included in this study. These patients were reviewed with a mean follow-up of 5.2 years and a questionnaire designed to assess the results was sent to their homes. RESULTS: 64% of patients no longer suffered from incontinence. Deterioration of the results was observed up to 5 years after the operation, but subsequently remained stable. The results were operator-independent. Low sphincter pressure (< 30 cm H2O), preoperative detrusor instability, insufficient hormonal impregnation and a history of pelvic surgery were the main factors predictive of failure of this technique. CONCLUSION: This study confirms the benefit provided by this technique in almost two-thirds of patients and indicates the risk factors of failure which must be taken into account before proposing Burch indirect colposuspension to a woman suffering from urinary stress incontinence.

Adult↗
PubMed1997

[Study of in vitro activity of 3 cephalosporins and their combination with 2 beta-lactamase inhibitors against 4 enterobacteria strains producing extended spectrum beta-lactamase].

The in vitro antibacterial activity of cefotaxime, cefepime and cefpirome was evaluated alone and in association with two beta-lactamase inhibitors: clavulanic acid and sulbactam against 65 extended broad spectrum beta-lactamase producing enterobacteriaceae strains [Klebsiella pneumoniae (35), Proteus mirabilis (9), Escherichia coli (11), Enterobacter aerogenes (10)]. The lowest MICs were observed for cefepime and cefpirome used alone. In association with inhibitors cefotaxime was less effective against E. aerogenes. Most isolates of K. pneumoniae, P. mirabilis, E. coli were susceptible to all the different tested associations.

Cephalosporins↗
PubMed1996

Acute leukaemia in paroxysmal nocturnal haemoglobinuria. Case report and review of the literature.

Paroxysmal nocturnal haemoglobinuria (PNH) terminating in acute leukaemia (AL) is an infrequent condition. In several cases, flow cytometric analysis of glycosylphosphatidylinositol anchored membrane proteins such as DAF and CD59/MACIF has suggested the leukaemic cells to be derived from the PNH clone, thereby implicating PNH as a potential preleukaemic disease. In the present paper, we review the data for one patient treated in our hospital and 20 cases reported in the literature from 1969 to 1993. The sex ratio is 1 female/2 males, mean age at diagnosis of PNH was 46 years and the mean interval between the diagnoses of PNH and AL was 53 months. AL type was AML M6 in 8 patients, other types of AML in 12 and ALL in one, with a mean survival of 7.1 months following diagnosis of AL. In all cases analyzed, the PNH phenotype of erythrocytes disappeared with progression of AL, whereas reappearance of this phenotype with complete remission of AL was inconstant. PNH would thus appear to be a potential preleukemic disease. When this disorder terminates in AL, the type is often AML M6, although ALL is also possible. The prognosis of AL in PNH is poor as for other secondary leukaemias. Apart from marrow aplasia, leukaemic transformation is another life threatening complication of PNH which may justify allogeneic bone marrow transplantation (allo-BMT) and potential leukaemic transformation can therefore be an additional argument in favour of allo-BMT when pancytopenia develops in PNH patients.

Acute Disease↗
PubMed1996

Transient complete remission of acute lymphoblastic leukemia in relapse after allogeneic bone marrow transplantation induced by donor leukocyte transfusions.

We report the case of a young patient with refractory acute lymphoblastic leukemia relapse, after allogeneic bone marrow transplantation, who was treated by donor leukocyte infusions. We observed potent adoptive immunotherapy which produced a cytologic complete remission and total chimeric state. This was of short duration and the patient died of severe graft-versus-host disease. We present a short summary of the literature concerning acute lymphoblastic leukemia and donor leukocyte infusions.

Adolescent↗
PubMed1996

[Combined renal-pancreas transplantation in the treatment for chronic renal insufficiency of diabetic origin . Results from the Pitie Urology Clinic].

Between 1989 and 1995, 32 patients underwent combined kidney-pancreas transplantation for diabetic chronic renal failure. Only one of these patients received an isolated pancreas following cessation of function of a previously implanted segmental pancreas. The surgical technique always consisted of pure retroperitoneal transplantation into the right iliac fossa of a total pancreas transplant with duodenovesical anastomosis. The postoperative complications included one death on D10 from pulmonary vein thrombosis in a patient with sickle cell anaemia and early loss of the transplanted pancreas due to venous thrombosis. Nine patients underwent at least one surgical revision, due to a leaking duodenovesical anastomosis in 8 cases. With a mean follow-up of 33 +/- 20 months, the results demonstrate, apart from the early death indicated above, another death at 50 months of a patient who had lost his pancreas due to early venous thrombosis and who died with a functioning kidney. 23 of the 30 surviving patients have a functioning kidney and pancreas (79%), i.e. 74% of the total population of 32 patients. Loss of pancreatic function was surgical in two cases (one case of infection of the transplant site, one case of thrombosis), vascular in one case due to rupture of a mycotic aneurysm into the duodenum and immunological in three cases: two of these pancreases retained partial function allowing perfect blood glucose control with less than 10 units of ordinary insulin per day. Lastly, a perfectly functioning pancreas was removed 13 months after transplantation because of renal rejection not controlled by reinforced immunosuppression. Compared to the data of the international registry, these results demonstrate the value of the retroperitoneal approach used in this series and the improvement of the results obtained with increasing experience of the transplant team.

Adult↗
PubMed1996

[Secondary management of urethral injuries].

In 80 to 90% of the cases of partial or complete rupture of the membranous urethra, early en-to-end urethroplasy is successful in re-establishing the urethra. Secondary or delayed treatment of urethral injuries is required in unsuccessful cases or when a surgical procedure cannot be performed within the first 10 days following injury as often occurs in polytrauma patients with fractured pelvis, pulmonary or cerebral contusions, or spinal fractures. Over the last 5 years, at the urology unit at the Pitié Hospital we have treated an equal number of patients immediately after injury and in procedures delayed for 4 to 6 weeks.

Humans↗
PubMed1995

Thrombopoietic effects and toxicity of interleukin-6 in patients with ovarian cancer before and after chemotherapy: a multicentric placebo-controlled, randomized phase Ib study.

Recombinant human interleukin-6 (IL-6) has previously been shown to increase platelet counts in normal and sublethally irradiated mice, dogs, and primates. To assess its tolerance and efficacy in clinical use, we performed a randomized phase Ib study in patients with ovarian carcinoma. IL-6 was administered during an initial 7-day cycle before any chemotherapy. Beginning 7 days later, six cycles of chemotherapy containing carboplatin were administered every 3 weeks. During chemotherapy cycles 2 to 6, IL-6 was administered from day 4 through day 17 at escalating dose levels from 0.5 to 10 micrograms/kg/d. At each level, three patients received IL-6 and one patient received a placebo. During the prechemotherapy cycle of IL-6, a dose-dependent increase in platelet count was observed from day 12 to 15 and was maximal on day 15 (r = .77; P < .01). The median ploidy of bone marrow megakaryocytes shifted from 16 N to 32 N after 7 days of the initial prechemotherapy IL-6 administration. Dose-dependent increases in C-reactive protein (CRP) and fibrinogen levels were observed on day 8 (P < .0001 for both). A significant decrease in hemoglobin level occured rapidly after initiation of IL-6 therapy and was maximal on day 8 (P < .001). When given after chemotherapy, IL-6 accelerated platelet recovery after chemotherapy cycles 2 to 6. Postponements of scheduled chemotherapy due to thrombocytopenia were less frequent in patients treated with IL-6. No difference in either neutrophils or peripheral blood progenitor assays was observed during or after IL-6 treatment. Toxicity of IL-6 appeared mild and was not dose-limiting up to 10 micrograms/kg/d. Systemic symptoms such as fever, headache, and myalgia were the main side effects and were easily relieved by acetaminophen administration. No biologic toxicity was observed. The data indicate that IL-6 is a well-tolerated cytokine and capable of accelerating platelet recovery in patients receiving chemotherapy.

Acute-Phase Proteins↗